Breast implants are the most tried-and-true method of increasing a breast size. With breast implants, we can consistently deliver the exact breast size that you patient want. You can try on the implants, we can use 3D imaging, and we can even use a virtual reality system to show you exactly what you will look like afterwards. Breast implants have been used for over 45 years to provide women with very natural-appearing enhancements of their breasts.
In some patients we can remove fat from unwanted areas using liposuction. In those patients we can use a specialized technique to harvest that fat and then transfer it to the breast to increase the breast size. The big advantage there is that there are no implants or foreign body in the body afterwards. This provides the most natural breast augmentation possible. The limiting factor for most patients in deciding whether or not they want to use their own fat as an alternative to breast implants is really two-fold:
- Whether they have enough fat to give
- Whether or not they have enough breast tissue to start with in order for the fat to have a “home” when we transfer
In general, the best patient for fat transfer to the breast is a woman who has a fair amount of breast tissue to start with, who has a fair amount of extra fat in an unwanted area, and who, at the end of the day, wants a small augmentation. Conversely, a woman who has very little extra fat to give or who has very little breast tissue to start with is going to get a much better result from breast implants.
The big advantage of silicone implants is that they are far and away the softest breast implants on the market. If you are looking for the most natural-looking and the most natural-feeling breast implant, there is no question that you are going to be happy with a silicone breast implant.
Silicone breast implants are among the most studied medical devices in the world, and to date all of our research shows that there is absolutely no health risk from silicone implants. Moreover, what we use now are “gummy bear breast implants”: highly cohesive silicone gel implants that tend to hold their form even in the event of breakage. This means you do not have to worry about leaking or spreading of the silicone. They are truly safe and the softest, most natural-feeling implant on the market.
The advantages of saline implants are two-fold:
- They are a little bit less expensive than silicone implants.
- They are filled with just saltwater, so in the event of breakage, there is absolutely no risk to a person’s health because the saltwater is essentially peed out over a day or so.
For women who want an unnatural appearance and want to really have a round, obviously augmented look, saline implants do provide a more unnatural look, if that’s what the patient desires. In summary, both implants have tremendous advantages.
In general, placing breast implants under the muscle allows them to appear much more natural. It decreases the rate of infection associated with the implants and decreases the rate of complications associated with the implants. It allows the breast implants to sit higher for longer and have more support and less tendency to drop or droop with time. There is also lower incidence or rate of capsular contracture. In other words, the breast implants tend to stay softer for longer under the muscle than they do over the muscle.
Over-the-muscle augmentation is best performed in patients who are extreme weight lifters and who are unwilling to sacrifice any bench-press or butterfly-press strength. It’s also best in patients who want more of an unnatural appearance. If your goal is to have a natural-appearing breast augmentation result that has the longest-lasting result and maintains the implants as soft as they possibly can be while also minimizing infections and other complications, we recommend breast augmentation under the muscle. If you want a very unnatural appearance or obviously augmented appearance or if you are an extreme weight-lifter, then we recommend breast augmentation over the muscle. Check out our video on the breast implant placement!
The answer to that really depends not only on your body frame and size but also your tastes. Selecting the right breast implant size is a multi-step process in our hands. It begins with you bringing in “wish pictures” (often found on the Internet) to tell us or show us what breasts you like. From there, we actually let you try on breast implant sizers. We let you look in the mirror at what those breast implants are going to look like and feel like on you. From there. we perform unique Crisalix 3D imaging, during which we show you a three-dimensional image of yourself with that breast implant size in to give you another way to make the decision.
To confirm the decision, we’ll use a new virtual reality system that we have. We’ll actually let you step into a virtual world, where you have the breast implants in place and can look at yourself from all sorts of different angles, including down at your chest, and see the breast implants in place. We believe that by using a combination of wish pictures, trying the physical breast implants on, three-dimensional imaging, and virtual reality, we can select the perfect breast implant size for you.
Breast implant manufacturers have created what they call different profiles of breast implants. For a given breast implant size, there is a slightly different shape to the breast implant. As we go up in profile from a moderate profile implant to a moderate plus profile implant or a high profile implant, the higher profile tends to extend further away from the chest. As we go up in profile for a given breast implant size, the implants also become narrower so that a breast implant that is a high profile implant will be much narrower across the chest than would a moderate or moderate plus profile implant.
The significance of that is two-fold: When we are selecting the implant profile, we want to maximize not only how much the breast implants extends away from the chest, but we also want to match the breast implant profile to your chest width because we want to make sure that the breast implants cover the entire chest width so that we can really maximize the cleavage in the middle, while not overdoing it or creating a “uni-boob” or “side boob” look.
We believe that maximizing the cleavage in the middle is just as important as maximizing how much the breast implant extends away from the chest. As we are selecting the different breast implant profiles, we’ll actually have you try the breast implants on in our office. We will have you select the volume, and once you select the volume that you like, we will then match that to the width of your chest and your dimensions in order to select the perfect implant dimensions and profile for that volume.
Then we will show that to you in our three-dimensional imaging system and also on our virtual reality system, so you can ensure that you are getting the perfect breast implant for you. Check out our video on breast implant profile selection.
There are four commonly performed approaches for breast augmentation. These include the following:
- The first is a trans-axillary approach, which is an armpit incision. The advantage to this is, of course, that there is no scar on the breast. The disadvantage to this is that the scar is quite noticeable and can be seen anytime you wear sleeveless clothing. In a hot environment such as Texas, we do not recommend this approach, as it will be probably the most noticeable of all of the incisions. Every time you wear sleeveless clothing, everyone will know that you’ve had breast augmentation surgery.
- The next option is the trans-umbilical or “belly button” approach. The obvious advantage to this is, again, that there no scar on the breast. The disadvantage is that we have to drag the implants from the belly button up to the breast. In the process, we can create micro-fractures on the shells of the implants, which can significantly decrease their life expectancy.
- We definitely do not want to do this because we want to make sure that the implants will last as long as they can and give you the best and longest-lasting results. This approach significantly compromises their implants. In addition, because the access incision is placed so far away from where we are placing the breast implants, it’s very, very difficult to accurately place the breast implants. While we do remove the scar from the breast, we also create a situation where it becomes very difficult to accurately locate the breast implants. This significantly increases the risk that you experience lopsidedness or asymmetry between the two breasts.
- The next approach is to go through the nipple. The advantage there is, of course, that the scar hides in the collar of the nipple. The disadvantage is that we’re cutting directly along the nerves that supply the nipple, which means decreased sensation and decreased ability to breastfeed.
- The final approach is the infra-mammary or under-the-breast approach. Hiding the scar underneath the breast makes it visible only when you are completely naked and someone is below you, lifting the breast and looking up. This is far and away, in our opinion, the best hidden of all of the incisions. It provides the best visualization for the surgeon, which ensures that you have the most accurate implant placement so that the breast implants can sit as symmetrically as possible. It is also, in our opinion, the least visible of all of the incisions. It is the incision recommended for the majority of our patients. It also allows us to stay far away from the milk ducts, which means that it will have no effect on breastfeeding over the long-term as well.
This is one of the most common questions that we receive when patients come to our offices. The answer to this really requires an in-person examination to determine the location of the breast tissue and where we want it to be after the augmentation.
At the consultation we will take specific measurements designed to help us determine whether or not doing a breast lift or just a straightforward breast augmentation is better in a given case. We will also run 3D simulations with and without breast lifts so that you can see what the benefits and the downsides of a breast lift would be for you. We will also review patients who are similar to them and on whom we have performed either breast augmentation alone or breast augmentation with lifts, so you can look at the cases side-by-side and determine which look is best for you.
There are multiple ways to perform a breast lift with implants. A breast lift can involve scars that are either just at the very top of the nipple; all the way around the nipple; all the way around the nipple and down the front; or all the way around the nipple, down the front, and underneath the breast. There are multiple options. When we are trying to determine which is the best option, it really depends on how high we have to move the breast.
In general, we’ll do everything we can to minimize the scars and incisions that need to be placed. Based on specific measurements that we take while you are in the office, we determine how high we need to move the breast tissue during the breast augmentation and lift procedure. How high we have to move it will determine which of these scar patterns is the best scar pattern for you. We will also show you the pictures of others who have had that scar pattern performed and what it looks like over the long-term because we want you to feel comfortable with the decision about your breast lift.
Breast augmentation is a one-hour surgery. You will return home the same day. We expect you to be up and walking around the house that afternoon or evening. We typically want you back to work 48 hours post-op. We want you back to the gym for cardio at three weeks. For weight training; yoga training; P90X®; T25®; or any sort of course, training, or strengthening exercises, we recommend waiting six weeks.
The answer to this question lies in what type of work you do. If you have a typical desk job, you can generally return to work within 48 hours. One of the things that we will do at your consultation is specifically discuss your work requirements and what your specific job functions are. If you have a more physically active job, we may tailor a return-to-work schedule to what is necessary in order to perform all of the tasks at your job.
In general, we allow patients to return to cardiovascular exercise at three weeks. This can include jogging, running, treadmill, seated exercise bike, StairMaster®, etc.We recommend waiting six weeks for core strengthening; weight training; yoga training; and some of the newer total-body workout videos such as P90X®, T25®, Insanity®, etc.
12. What steps will the plastic surgeon take to minimize my risks of infection or other complications from the procedure?
We take a multi-step approach to try to reduce the risk of infections prior to the breast augmentation procedure. This begins the night before the surgery when we give you a prescription surgical wash to decrease the amount of bacteria that is on your skin prior to the breast augmentation surgery. On the morning of the surgery, we administer intravenous antibiotics before the procedure starts so that any bacteria that tries to get in during the surgery is immediately met with a strong dose of antibiotics to kill them. We wash the surgical site with a very strong antiseptic soap to again decrease the bacterial content on the skin prior to surgery.
We use nipple shields in the operating room to avoid bacterial contamination from the nipples. When it comes to placing the implants themselves, we use a no-touch technique and a very advanced method of placing the implants that involves a Keller Funnel™, which allows us to place the implants without actually ever touching them. In so doing, we can ensure that there is absolutely no chance for bacterial contamination of the implants.
At the conclusion of the surgery, we not only sew the incision shut but actually add an antiseptic skin glue, which lasts approximately three weeks, to the top of the incision. The skin glue prevent bacteria from getting into the incision during the first three weeks after surgery. We send you home with enough antibiotics for five days. These antibiotics are designed specifically to target the bacteria that like to attack breast implants. By using this multi-modal approach, we find that we can take the breast implant infection rate as close to zero as is reported anywhere.
During our consultation, we perform an examination on you and a thorough review of your medical problems, as well as your medications, to determine if you are healthy enough to have a breast augmentation. If you do have any significant medical problems, we take a team approach and consult with your primary care doctor and/or any specialty doctors that you use in order to determine not only if you are healthy enough to have a breast augmentation but also what the additional risks might be and what special steps we might have to take in your case specifically to ensure that we have a safe and complication-free experience.
We will do a thorough review of the medications you are taking prior to the breast augmentation so that we can ensure that none of them interact with the medications that we administer during the surgery and to ensure that none of them increase any risks of complications after the surgery. If any of your medications do put you at additional risk, we will work with the primary care or specialty care doctor who originally prescribed the medications to tailor them or switch them prior to your surgery in order to minimize any risk of complications.
We will ask you, in general, to stop all contraceptives two weeks prior to the surgery to minimize risks of blood clotting. We will also ask you to stop taking aspirin, Ibuprofen and Motrin® 10 days pre-op, as well as fish oils, omega-3s, etc., to minimize the risk of bleeding associated with them.
Nicotine causes the tiny blood vessels in your body to clamp down. When they do, healing wounds don’t get enough blood flow. If you smoke around the time of surgery, you have a significantly increased risk of wound-healing problems and infections associated with the surgery period. Because of this, we require all of our patients to be nicotine-free for four weeks before the surgery and for six weeks after the surgery. While we certainly recommend nicotine cessation over the long-term, once you pass six weeks, and everything is healing well, we do allow our patients to return to smoking, if they so desire.
We are very pleased to announce that we have our own plastic-surgery-specific and optimized surgery center called Virtuoso Surgery Center. The wonderful thing about this is that the surgery center is set up and designed specifically and only for plastic surgery.
We have the latest technology to provide not only the safest but also the most precise breast augmentations possible. All of our staff members are highly trained and work specifically on plastic surgery patients all day, every day so that they are able to provide not only the most empathetic but also the most accurate and safe care for you, since they know exactly what they are doing. This includes our specific team of not only anesthesiologists but nurses, scrub techs, first assistants, etc.
Finally, because all of the services performed in the surgery center are specifically plastic surgical procedures, we minimize your risk of picking up the hospital-associated infections that can be a problem if you have your surgery in a hospital setting as many of our competitors unfortunately subject their patients to. The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) is one of the largest surgery center governing bodies in the world. The accreditation and outside inspection process of Virtuoso Surgery Center ensures that we are providing the safest possible environment for our patients to have surgery.
If you are considering elective cosmetic surgery and the surgeon you are using does not have an independent accreditation organization such as AAAASF checking the quality, cleanliness, and results of the surgery center and the surgeons using it, you are placing yourself and your health at risk!
We want your breast augmentation to be a completely pain-free experience. As a result, we will provide a general anesthesia, which means that you will be totally asleep for the surgery. This is far and away the safest and most comfortable way for you to have a breast augmentation.
We use MD-only, board-certified anesthesiologists to perform our breast augmentations. We believe that the person who puts you to sleep for your surgery is every bit as critical as your surgeon. As a result, we insist on only the very best anesthesiologists who have extensive experience specifically in plastic surgery and specifically in breast augmentations. We do not use CRNAs, and we do not use OR Nurse-Anesthetists. While this may cost more, this is designed to ensure total safety and comfort during the procedure.
Our board-certified MD-anesthesiologist will have you 100% asleep for the surgery, so you will feel absolutely nothing during your breast augmentation surgery. You will drift off to sleep, and when you wake up, you’ll be in love with your new look.
20. Why is board certification in plastic surgery critical to ensuring the best outcomes for my breast implant surgery?
Breast augmentation is a very serious surgery and should be treated as such. This is your body and you’re going to have these breast implants for many, many years, hopefully. Like anything else in life, you will have the best results if the surgery is done right the first time. To ensure that it’s done right the first time, you want to select a surgeon such as Dr. Obaid or Dr. Ver Halen, both of whom are board-certified specifically in the field of plastic surgery.
Unfortunately, there are a lot of deceptive marketing practices in our area. In fact, within just a few minutes’ drive from our office, you can have your breast augmentation surgery done by an orthopedic surgeon, by a primary care doctor, by an OB-GYN, and even by a dentist. These people are not formally trained in an american college or graduate medical education residency program specifically designed to teach them how to do breast augmentations and plastic surgery. Because they have not spent years studying this, you will be placing your body in the hands of someone who may not have the expertise necessary for you to achieve the perfect result.
Please be aware of deceptive marketing practices when you are shopping for your breast augmentation. If someone tells you that they are board-certified, please insist on knowing what they are board-certified in. Are they board-certified in plastic surgery, or are they board-certified in OB-GYN or primary care? There is a critical difference. When people tell you that they are board-certified in “cosmetic” surgery, please note that there is no American college or graduate medical education formal training program for cosmetic surgery.
As a result, the training that these surgeons have is far less than those of a board-certified plastic surgeon. It goes without saying that if someone has not formally trained and been educated in this, your results and the consistency of your results will often not be up to par. Dr. Obaid and Dr. Ver Halen were both educated at Harvard Medical School. Dr. Obaid did his formal plastic surgery training at the University of Texas-Southwestern Medical Center in Dallas. Beyond that, he completed a fellowship at New York University. He has been board-certified by the American Board of Plastic Surgery and participates in the maintenance of certification program provided by the American Board of Plastic Surgery to ensure that he is at the forefront of the most cutting-edge and up-to-date research on breast augmentation.
Following your breast augmentation surgery, you will have formal followup visits: at one week post-op, three weeks post-op, six weeks post-op, and six months post-op. They are all included in the cost of your procedure. In addition, we take great pride in making himself available to all of his patients. Dr. Obaid will provide you, on the day of surgery, with his cellphone number. If you have any need, at any hour of the day or night, you will be encouraged to call us and know that someone is always there for you.
We take the followup after your breast augmentation surgery very seriously, as we believe that it’s a critical part of the recovery process and a critical component of ensuring that you have the perfect breast augmentation result.
Immediately after an under-the-muscle breast augmentation surgery, the breast implants tend to ride very, very high. This is a normal part of the process, as the muscle must be stretched over time to accommodate the breast implant. As it stretches, the breast implants will descend and drop into the pocket, creating a very natural look.
In order to ensure that the breast implants are settling right, our nurses and Dr. Obaid work one-on-one with you to teach you post-operative implant massage exercises to ensure that they settle exactly how we want them to.
When Dr. Obaid or Dr. Ver Halen performs an under-the-muscle breast augmentation surgery, performed through a tiny incision underneath the breast, he takes great care to ensure that he does not disturb any of the milk ducts that are critical for producing the breast milk. As a result, you should expect that the surgery will have no effect on your ability to breastfeed and that you should be able to breastfeed normally after your breast augmentation surgery.
24. What before-and-after photos of other patients can you show me that will help me feel confident that I have picked the right surgeon?
Dr. Obaid and Dr. Ver Halen have extensive experience specifically in breast augmentation surgery. As a result, we have made available online many, many before-and-after photos for you to peruse to make sure that you see the results that you are looking for. Please follow this link to see them: breast augmentation before-and-after photos.
We use the Crisalix 3D Breast Imaging System, which allows us to image your breasts at your consultation so that during that consultation, you will be able to see exactly what the breast implant size that you have selected is going to look like on your body. Moreover, we will email these results to you so that you can look at them at home and share them with any loved ones or friends.
We believe that the 3D Imaging process is critical to ensuring that the perfect breast implant size is selected and to ensuring the highest level of patient satisfaction. If your surgeon is not using this, you should be very wary of how far behind they are, technologically. You should also be concerned as to whether or not you’re selecting the right breast implant size. We believe this technology is a critical component of breast implant selection today.
Breast augmentation is the number-one surgery that Dr. Obaid performs. He performs many breast augmentations every single operative day of the week. In addition, the anesthesiologist and the nurses that work on his team do this as well. The result is that everyone knows their roles. Because Dr. Obaid has extensive experience performing this operation, it can be done in the most precise manner, which leads to the best cosmetic results.
In addition to performing 3D imaging, we also have a brand new, state-of-the-art plastic surgery virtual reality system that allows you to step into a world in which you have already gone through the surgery and can see your breast implants as you look down at your body and as you look from side-to-side. We believe that this is the most cutting-edge tool available today for ensuring that we select the perfect breast implant for you, and we’ll make it available at your consultation.
28. What is capsular contracture? What will my surgeon do to prevent capsular contracture of my breast implants?
Capsular contracture is a hardening of the breast implants that occurs because of excessive scar tissue buildup around the breast implants. Current research suggests that the cause of the hardening and scar tissue formation is microscopic bacterial contamination of the implant, allergic reactions to the implants, implant rupture, or blood around the implants. We take great care to minimize the risk of capsular contracture. We use a combination of five different antibiotics over the course of your treatment to prevent infection, and we use preoperative surgical washing with surgical soap that is prescription-strength to, again, minimize the risk of infection. We use a Keller Funnel™ and a no-touch technique to place the implants to minimize the risk of infection. In so doing, we have been able to achieve extremely low rates of capsular contracture.
In addition, we take great care to ensure that the surgery is bloodless and that any blood that is seen is absolutely irrigated and washed out to ensure that no blood comes in contact with the implant, thereby minimizing the contribution of blood to scar formation and capsular contracture formation. In addition, an anti-inflammatory medication will be prescribed to you at the time of your breast augmentation surgery to minimize your body’s tendency to form scars and minimize any allergic reaction to the implants. Finally, we take great care to select the highest-quality breast implants with the lowest possible rupture rate to, again, try to minimize the risk of rupture and, subsequently, capsular contracture. Click to see our video on capsular contracture.
We insist that the breast implant companies stand behind their work. We only use breast implant manufacturers that offer warranty. For the specific warranty that will be provided with your surgery, please ask your patient care coordinator at the time of your visit, as it will depend upon which implant is selected at the time of your consultation.
We use the latest, highly cohesive gel silicone implants that also go by the name “gummy bear” implants in the press. These implants have silicone molecules that are cross-linked with each other to minimize any potential for leakage. While nothing in this world is 100% unbreakable, the implants we use for your surgery have an extremely low rupture rate so that you can be confident that you will have them to enjoy for years to come.
Rippling of the skin after breast augmentation occurs when the skin that is overlying the breast implant is too thin, and, as a result, the little contour irregularities that can be present in the breast implant are seen through the skin. To minimize your risk of rippling, we will place the implants underneath the pectoralis muscle. This provides a thick layer of coverage, which helps to camouflage the implant from any irregularities that are seen on the surface.
The rate of rippling of breast implants is extremely low in Dr. Obaid’s hands. If you have experienced breast implant from a previous surgery performed elsewhere, please contact us for correction of this, as there are many options now for correction, including the placement of dermal substitutes, which can thicken the skin and hide the implant better. In addition, there is also the ability to potentially remove a small amount of fat from elsewhere and graft that into the area to help camouflage things.
Please be aware that the hormones of pregnancy, combined with the weight fluctuations of pregnancy, will cause your breasts to potentially increase significantly in size. When those hormones go away, the breast tissue may or may not shrink down, depending upon your skin elasticity. If it does, then you should continue to have a fantastic result from your breast augmentation. Occasionally, there is some loose skin that is created because of pregnancy that can typically be corrected with a small skin removal or a small breast lift.
The outer surface of a breast implant can either have a smooth surface or a slightly rough surface. This is not something that you feel externally but is only seen internally. It will only be seen by your surgeon on the day that they place your implant.
Both smooth and textured implants have a lot of great advantages. Smooth silicone breast implants are, far and away, the softest breast implant out of the box on the market. As a result, if everything goes perfectly during your surgery, and there are no complications, a smooth silicone will provide the softest and most natural feel.
The textured, slightly rough coating is applied to the breast implant by the manufacturer for two reasons. The first is to help decrease scar formation around the implant, such that while a smooth implant may feel softer out of the box, many times a textured implant actually feels softer in the body because the body forms less scar tissue around it. The formation of less scar tissue decreases the risk of capsular contracture and helps minimize complications from breast augmentation surgery. Oftentimes, texturing results in a lower complication rate. Second, the texturing allows the breast implant to anchor itself, in many cases, to the chest.
The result of this is that textured implants often drop less and move out to the side less over time than smooth implants. While textured implants are a little bit more firm out of the box, the advantages of the texturing can be a softer result in the patient because of less scarring; lower rates of capsular contracture and other complications; and a more stable, long-lasting precision to the breast implant.
If you desire a breast augmentation using your own fat, we will do a careful examination of unwanted areas of fat on your body to determine how much fat can be extracted and grafted to your breast. A 3D simulation will be performed so that you can see exactly what you would look like, not only with the fat transfer into your breast, but also with the fat removed from unwanted areas. A comparison will also be made to the use of breast implants so that you can see, three-dimensional, which is the best surgery for you.
We believe that the best sources for testimonials about and reviews of your breast augmentation surgery come from real patient ratings. Please visit our Patient Testimonials gallery to read about the experiences of other patients on whom Dr. Obaid and Dr. Ver Halen performed breast augmentation surgery to learn how they feel about the results. You can also view our Facebook, RealSelf, and Real Patient Ratings as well.
Dont find the questions you want in our Breast Augmentation FAQ page? Just call us: 817-416-8080! North Texas Plastic Surgery has offices in Southlake and Plano, and we serve patients throughout the Dallas area.